Factors contributing to the stock out of essential medicines at health facilities in Mbale District in Uganda.

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Introduction
Drugs play a crucial role in health restoration, prevention and diagnosis of various diseases. In Uganda, essential drugs are provided free of charge to patients in all public health facilities in order to ensure equitable access to health care. In Private-Not-For-Profit health facilities, drugs that are subsidized by Ministry of health through Credit line and Primary Health Care conditional Grant are provided free of charge to patients as well.
Statement of the problem: There is persistent shortage of essential drugs in health units in Mbale district. The problem seems to occur in both public and PNFP facilities. It is not clear where the problem originates in the drug management cycle and the extent not known. Therefore, there was need to investigate the cause in order to put appropriate actions in place.
Objectives of the study: This research was to assess the effectiveness of the procurement system for essential medicines at health facilities; determine the level of poly pharmacy at health facilities and determining the availability of the core essential medicines and supplies at health facilities in Mbale District in Uganda.
Methods: The study was cross sectional and focused on medicines procurement processes and rational medicines used in public and PNFP health facilities. It employed both qualitative and quantitative methods of data collection using Checklists, questionnaires, WHO modified drug use indicator form, and key informant interviews. Data was analyzed using SPSS statistical software for statistical analysis. Data was presented in tabular form, as bar charts and figures. Some of the qualitative data were manually analysed and presented in text.
Results: The study indicated that the procurement system in Mbale district is not effective. The drug management structure in the district is weak with no Medicine and therapeutics committee constituted. Procurement resources were lacking in the health facilities. It was noted that NMS supply about 52 % of the required drugs to public facilities while JMS supply over 91% to PNFP’S. It was also noted that public health facilities and PNFP’s take 70-79 and 7-8 days respectively from time of ordering to receiving the drugs.
Conclusion: The Procurement system in Mbale district is generally ineffective right from the health facility level irrespective of the ownership and factors contributing to this phenomenon needs to be addressed soon. Prescription practices which lead to medicines wastage need attention.
Recommendations: The researcher therefore recommended that in order to improve the
availability of essential medicines and health supplies at the health facilities in Mbale district, procurement processes should be adhered, use of treatment guidelines for selection of facility lists, regular technical support supervision through mentoring and coaching to the health unit staff and monitoring of medicine management activities. District health offices should ensure that the focal personnel on medicines procurement monitor the activities of the suppliers to ensure accurate information on availability of stocks with the suppliers. Improve staffing of technical personnel like the pharmacy technicians/dispensers at health facilities, encourage inservice training on medicines management and prescribing practices. The quality of training in logistics management should be ensured.